Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 036124141 | IL |
Y | 111NI0900X | Internist | 036124141 | IL |
NPI | 1003143801 |
---|---|
Provider Name | Dr. Alexander Feoktistov |
First Address | Northfield, IL 60093-2744 |
Second Address | Northfield, IL 60093-2744 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2009 |
Last Update Date | 02/09/2020 |